INTRODUCTION Multi-vessel coronary artery disease (MV-CAD) is common among patients with acute coronary syndrome (ACS) and is associated with worse outcomes. OBJECTIVES To examine temporal trends of patients presenting with ACS and MV-CAD. METHODS Time-dependent analysis of patients enrolled in the ACS Israeli Surveys (ACSIS) between 2004-2016 by 3 time periods: early (2004-2006; n = 2111), mid (2008-2010; n = 2049), and late (2013-2016; n = 2010). MV-CAD was defined as >50% stenosis in ≥2 separate coronary territories at the index coronary catheterization. Outcomes were 30-day MACE and 1-year all-cause mortality. RESULTS Overall 6170/9321 patients (66%) had MV-CAD (age 64.5 ± 12.1, males 80%). Patients from later periods were older with a higher prevalence of cardiovascular risk-factors and comorbidity. Among patients with MV-CAD, STEMI decreased significantly (early-46% vs. late-37%, p < 0.001). The rates of PCI were similar, however rates of MV-PCI have increased (early-16.8% vs. late -37.1%, p < 0.001) while the rates of CABG decreased over-time (early-12.7% vs. late -9.2%, p < 0.001). Thirty-day outcomes improved significantly; MACE (early-18.2%, mid-12.6%, late-11.2%, p < 0.001), mortality (early-4.7%, mid-4.2%, late-3.1%, p = 0.03) and re-infarction (early = 3.0%, mid = 2.4% and late 1.1%, p < 0.001). No significant change in 1-year mortality was observed (early = 9.3%, mid = 7.8%, late = 7.7%, p = 0.13). A multivariate adjusted analysis demonstrated that the mid and late periods (vs. the early period) were associated with significantly reduced risk for 30-day MACE (OR = 0.65 [0.54-0.77] and 0.54 [0.45-0.65], respectively). CONCLUSIONS During the last decade, the burden of cardiovascular risk factors among ACS patients with MV- CAD has increased, more invasive treatment was provided and a significant improvement in 30-day outcomes was observed.

中文翻译：

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急性冠脉综合征和多支冠状动脉疾病患者的时间趋势-来自ACSIS注册中心。

引言多血管冠状动脉疾病（MV-CAD）在急性冠脉综合征（ACS）患者中很常见，并且与较差的预后相关。目的探讨ACS和MV-CAD患者的时间趋势。方法对2004-2016年间ACS以色列调查（ACSIS）的患者进行3个时间段的时间依赖性分析：早期（2004-2006; n = 2111），中期（2008-2010; n = 2049）和晚期（ 2013-2016； n = 2010）。MV-CAD被定义为在进行冠状动脉导管插入术时≥2个单独的冠状动脉区域中狭窄> 50％。结果是30天MACE和1年全因死亡率。结果共有6170/9321例患者（66％）患有MV-CAD（年龄64.5±12.1，男性80％）。晚期的患者年龄较大，心血管危险因素和合并症的患病率较高。在MV-CAD患者中，STEMI显着降低（早期为46％，晚期为37％，p <0.001）。PCI的发生率相似，但是MV-PCI的发生率增加了（早期16.8％对晚期-37.1％，p <0.001），而CABG的发生率随着时间的推移而降低（早期12.7％对晚期-9.2）。 ％，p <0.001）。三十天的结局明显改善；MACE（早期-18.2％，中期-12.6％，晚期-11.2％，p <0.001），死亡率（早期-4.7％，中期-4.2％，晚期-3.1％，p = 0.03）和再次梗塞（早期= 3.0％，中位数= 2.4％，后期1.1％，p <0.001）。观察到1年死亡率无显着变化（早期= 9.3％，中期= 7.8％，晚期= 7.7％，p = 0.13）。多元校正分析表明，中期和晚期（相对于早期）与30天MACE的风险显着降低相关（OR分别为0.65 [0.54-0.77]和0.54 [0.45-0.65]）。